Navigating AI in Clinical Practice: Essential Ethics Questions Answered

As artificial intelligence tools become increasingly integrated into mental health practice, clinicians face important ethical questions about their appropriate use. We asked Frederic Reamer, a leading voice in clinical ethics, to address the most pressing concerns practitioners have about AI technology in therapeutic settings. See his answers below.

Clinical Documentation: Balancing Efficiency with Accuracy

Q: What are the pros and cons of using AI platforms to generate notes summarizing clinical encounters? Do I need my clients' consent to use this AI technology?

AI platforms designed to summarize clinical encounters can be a great timesaver. There's no doubt about that. That said, there are noteworthy risks. It's critically important to obtain clients' consent to use the AI tool for this purpose, including uploading the recording to a HIPAA-compliant platform. It's also important for clinicians to carefully proofread the AI-generated note to correct any errors or omissions. I advise clinicians to carefully document the steps they've taken to (1) obtain clients' consent and (2) proofread and, when necessary, edit any AI-generated notes. 

Risk Assessment: AI as Supplement, Not Substitute

Q: I've read that AI tools can be a powerful help when conducting risk assessments and forecasting clinical outcomes. Is this true? What are the potential benefits and risks?

 Here, too, AI tools can be very efficient and save time. Indeed, there are AI platforms designed to conduct clinical risk assessments. I advise clinicians who use these AI tools to assess risk to consider them as a supplemental tool rather than the primary tool for risk assessment. In my experience, clinicians expose themselves to considerable legal risk if they rely solely on AI tools to assess clinical risk, especially if there is a negative clinical outcome (e.g., a client dies by suicide) and questions surface about the quality of the clinician's risk assessment protocol.

Client Monitoring Tools: Promise and Precautions

Q: I like the idea that some AI tools may be able to help my clients monitor their moods and behavioral risks. What should I keep in mind if I am considering recommending these tools?

I agree that these AI tools can be helpful to clients. It is very important to screen the quality of these tools. And, importantly, clinicians should explain to clients the potential benefits and risks involved, including the possibility that these tools will generate inaccurate or misleading data. Clinicians should always exercise their own professional judgment about the status of clients' moods and behaviors and not rely solely on data generated by AI tools. 

Understanding and Preventing Algorithmic Bias

Q: In several commentaries I've read about potential problems with the use of AI in clinical settings, I've seen references to something called "algorithmic bias." What is this, exactly, and is there a way to prevent it?

Algorithmic bias in psychotherapy AI tools occurs when these systems produce systematically unfair or inaccurate outputs for certain groups of people. This typically happens because training data underrepresents certain populations by race, ethnicity, gender, sexual orientation, gender expression, age, or socioeconomic status, or because cultural assumptions are baked into assessment criteria. To prevent algorithmic bias, therapists should take several important steps. First, verify the training data by asking vendors about the diversity of populations used to develop their tools. Never rely solely on AI assessments—always cross-check outputs using clinical judgment and cultural context. Monitor for patterns by tracking whether AI tools produce different outcomes across demographic groups in your practice. Seek tools that have been validated across multiple populations, not just majority groups, and prioritize transparency by choosing AI systems that explain their reasoning. Maintain human oversight by keeping AI in a supportive role rather than allowing it to make diagnostic or treatment planning decisions independently.

Moving Forward Thoughtfully

As AI tools become more sophisticated and widely available, clinicians face the ongoing challenge of integrating technology responsibly into practice. The guidance Dr. Reamer provides emphasizes a consistent theme: AI should enhance, not replace, clinical judgment and the therapeutic relationship.

By obtaining informed consent, maintaining quality control, preventing algorithmic bias, and keeping human expertise at the center of clinical care, mental health professionals can harness AI's benefits while protecting clients from its risks. The goal isn't to resist technological advancement but to implement it thoughtfully, ethically, and always in service of client wellbeing.

And the questions explored here are just the beginning. If you're looking for comprehensive guidance on integrating AI into your practice ethically and effectively, join us for AI in Behavioral Health: Mastering Ethical Integration & Clinical Applications with Dr. Frederic Reamer. This expert-led training will equip you with practical strategies for leveraging AI tools while maintaining the highest ethical standards and clinical judgment. You'll learn how to navigate the complex landscape of AI technology, protect your clients, and enhance your practice responsibly.